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Renal cell carcinoma and venous tumor thrombus: predicting sarcomatoid dedifferentiation through preoperative IVIM-based MR imaging

  • Kidneys, Ureters, Bladder, Retroperitoneum
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the value of preoperative intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI) and conventional MRI indicators in identifying sarcomatoid dedifferentiation in renal cell carcinoma (RCC) and tumor thrombus.

Methods

From September 2016 to April 2023, consecutive patients with RCC and tumor thrombus who received routine MRI examination and IVIM-DWI before radical resection were enrolled prospectively. Kaplan–Meier method with log-rank test was used to calculate and compare the survival probability. The preoperative imaging features were analyzed. Univariate and multivariable logistic regression analyses were employed to identify independent predictors of sarcomatoid dedifferentiation. The predictive ability was evaluated by receiver operating characteristic (ROC) curves.

Results

Twenty-two patients (15.3%) of the 144 patients in the training set (median age, 58.0 years [IQR, 52.0–65.0 years]; 108 men) and 11 patients (22.4%) of the 49 patients in the test set (median age, 58.0 years [IQR, 53.0–63.0 years]; 38 men) had sarcomatoid dedifferentiated tumors. Patients with sarcomatoid-differentiated tumors had poor progress-free survival in the training set and test set (P < 0.001 and P = 0.007). f value (P = 0.011), mN stage (P = 0.007), and necrosis (P = 0.041) were independent predictors for predicting sarcomatoid dedifferentiation in the training set. The model combining conventional MRI features and f value had AUCs of 0.832 (95% CI 0.755–0.909) and 0.825 (95% CI 0.702–0.948) in predicting sarcomatoid dedifferentiation in the training set and test set.

Conclusion

It is feasible to preoperatively identify sarcomatoid dedifferentiation based on IVIM-DWI and conventional MR imaging indicators.

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Data availability

The data sets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Abbreviations

RCC:

Renal cell carcinoma

OS:

Overall survival

IVIM-DWI:

Intravoxel incoherent motion diffusion-weighted imaging

IQR:

Interquartile range

CMP:

Corticomedullary phase

NP:

Nephrographic phase

NEX:

Number of excitations

T2LIA:

T2 low-intensity areas

ADC:

Apparent diffusion coefficient

ROI:

Regions of interest

BMI:

Body mass index

ISUP:

International Society of Urological Pathology

PFS:

Progression-free survival

SD:

Standard deviation

ICC:

Intraclass correlation coefficient

ROC:

Receiver operating characteristic

AUC:

Area under the ROC curve

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Acknowledgements

We acknowledge the patients whose samples/data provided the foundation for this study, and are grateful to the multidisciplinary team of urology in Chinese PLA General Hospital for their support and assistance.

Funding

This work was supported by the National Natural Science Foundation of China (Grant No. 81971580, 82271951) and Beijing Natural Science Foundation (7222167).

Author information

Author notes

  1. Jian Zhao, Xiaohui Ding, Shaopeng Zhou were equally contributed joint first authors.

  2. Haiyi Wang and Xu Zhang have contributed equally to the work.

Authors and Affiliations

  1. Department of Radiology, First Medical Center, Chinese PLA General Hospital, No. 28, Fuxing Road, Haidian District, Beijing, 100853, People’s Republic of China

    Jian Zhao, Shaopeng Zhou, Xu Bai, Xiaojing Zhang & Haiyi Wang

  2. Department of Radiology, Armed Police Force Hospital of Sichuan, Leshan, 614000, Sichuan, People’s Republic of China

    Jian Zhao

  3. Department of Pathology, First Medical Center, Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China

    Xiaohui Ding

  4. Department of Radiology, Sixth Medical Center, Chinese PLA General Hospital, Beijing, 100037, People’s Republic of China

    Meifeng Wang

  5. Department of Urology, Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China

    Cheng Peng, Kan Liu, Xin Ma & Xu Zhang

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  1. Jian Zhao
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Zhao, J., Ding, X., Zhou, S. et al. Renal cell carcinoma and venous tumor thrombus: predicting sarcomatoid dedifferentiation through preoperative IVIM-based MR imaging. Abdom Radiol (2024). https://doi.org/10.1007/s00261-024-04210-1

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  • DOI: https://doi.org/10.1007/s00261-024-04210-1

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